Prime Healthcare Services - Saint Clare's LLC
Prime Healthcare Services - Saint Clare's LLC was paid $700K by Medicaid between Jan 2018 and Jun 2023, across 20 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 33% of everything it billed.
DENVILLE, NJ 07834
Next to other General Acute Care Hospital providers in New Jersey
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Auditor's notes
Automated statistical signals. Not evidence of fraud — how these are computed.
Paid by month
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 5,996 | $240K | |
| 2019 | 4,554 | $164K | |
| 2020 | 3,477 | $125K | |
| 2021 | 1,863 | $78K | |
| 2022 | 1,959 | $59K | |
| 2023 | 1,229 | $34K |
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 33% | 5,701 | 3,527 | $229K |
| 99222 | Initial hospital care, per day, moderate complexity | 26% | 3,282 | 3,183 | $183K |
| 99214 | Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 7.9% | 1,307 | 1,024 | $55K |
| 99232 | Hospital visit by a doctor, follow-up daySubsequent hospital care, per day, moderate complexity | 5.0% | 1,036 | 824 | $35K |
| 99233 | Hospital visit by a doctor, follow-up day (complex)Prolong inpt eval add15 m | 4.9% | 804 | 677 | $35K |
| 99223 | Prolong inpt eval add15 m | 3.9% | 343 | 336 | $28K |
| 76816 | Ultrasound, pregnant uterus, real time with image documentation, follow-up | 3.9% | 1,782 | 1,473 | $27K |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 3.4% | 762 | 630 | $24K |
| 76819 | Fetal biophysical profile; without non-stress testing | 3.1% | 776 | 646 | $22K |
| 76811 | Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed | 2.0% | 199 | 194 | $14K |
| 59430 | 1.7% | 257 | 241 | $12K | |
| 99221 | 1.2% | 225 | 216 | $8K |
8 more codes
| 93010 | Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only | 1.1% | 1,986 | $8K |
| 99203 | Doctor's office visit, new patient (routine) | 1.1% | 137 | $7K |
| 99239 | Hospital discharge day management, more than 30 minutes | <1% | 132 | $6K |
| 99204 | Doctor's office visit, new patient (more involved) | <1% | 66 | $5K |
| 76813 | <1% | 37 | $1K | |
| 93306 | Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete | <1% | 14 | $350.18 |
| 0503F | 0% | 34 | $0.00 | |
| 0502F | 0% | 198 | $0.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
Who's on the registration
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.